Account Credit Application
Sold To Name Ship To Name
Sold To Address Ship To Address
Sold To City Ship To City
Sold To State Ship To State
Sold To Zip Ship To Zip
Phone Fax
       
  President / Owner  
  Purchasing Agent  
  Accounts Payable Contact  
  Company Type  
  Tax ID or SS#  
  Tax Exempt # (Please send copy of tax exempt form or resale certificate)  
  Number of Employees  
  Type of Shop  
     
 
Bank Information
  
  Name  
  Address  
  City  
  State  
  Zip  
  Contact  
  Phone  
       
 
Credit References
 
       
  Credit Reference #1 Credit Reference #2 Credit Reference #3
Name
Address
City
State
Zip
Phone
Fax